The advice is to investigate and treat the vitamin B12 deficiency in the normal way, following clinical guidelines, and to continue the metformin
Potential interactions include: Metformin (used for type 2 diabetes) Proton pump inhibitors (PPIs) and H2-receptor antagonists (used for acid reflux) Colchicine (used for gout) Nitrous oxide (anaesthetic gas that can inactivate B12) Chloramphenicol (may reduce the haematological response to B12 therapy) If you take any of these medications long-term, discuss B12 monitoring with your healthcare provider
In that case, be sure to stick to the recommended vitamin B12 dosage, and use only as directed
Neurological symptoms represent a significant concern with B12 deficiency and may include: Paraesthesia (pins and needles) in the hands and feet Difficulty with balance and coordination Memory problems or cognitive changes Mood disturbances , including depression or irritability Glossitis (sore, red tongue) and mouth ulcers Haematological manifestations of B12 deficiency include megaloblastic anaemia , characterised by the production of abnormally large, immature red blood cells
If you are recommended to have joint injections, its unlikely that it will be a one-off treatment
There is no advantage to using the light sensitive forms of cobalamin, such as methylB 12 or adenosylB 12 , instead of the stable cyano or hydroxy forms, which are readily converted in the body into the coenzyme forms, methylB 12 and adenosylB 12
